Cognitive aids: time for a change?

Jenkins, B. J.

doi:10.1111/anae.12764

Cited by 21 publications

(26 citation statements)

References 33 publications

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“…Paediatric advanced life support [23] Published by Resuscitation Council (UK) in 2010 Shoulder dystocia [24] Published by the Royal College of Obstetricians and Gynaecologists (UK) in 2012 Severe acute asthma [25] Published by British Thoracic Society and Scottish Intercollegiate Guidelines Network (revised) 2012 [26], Jenkins asserted that design of cognitive aids is important, and that poor design can lead to patient harm; he proposed the development of new aids for the management of anaesthetic room emergencies. We believe that our tool is the only one currently available to guide the design of future cognitive aids.…”

Section: Cognitive Aid Descriptionmentioning

confidence: 99%

Cognitive Aids in Medicine Assessment Tool (CMAT): preliminary validation of a novel tool for the assessment of emergency cognitive aids

et al. 2015

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Summary Applying human factors principles to the design of clinical emergency guidelines is important. The UK Civil Aviation Authority uses a Checklist Assessment Tool for evaluating the content and usability of emergency drills before introduction into service on aircraft. We hypothesised that this model could be used to develop a generic medical tool. A three‐stage modified Delphi process was used to adapt the above tool for use in designing medical emergency guidelines. The resulting Cognitive aids in Medicine Assessment Tool was then used to score and rank seven published difficult airway guidelines; the scores were used to assess its validity and reliability. Pearson's rank coefficient between these scores and scores from independent assessors was 0.89 (p = 0.007). Internal consistency, as assessed by Cronbach's alpha, was 0.74, 0.96 and 0.72 for the tool's three constituent domains of physical characteristics, content and layout/format, respectively. Inter‐rater reliability, as assessed by Cohen's kappa, ranged from 0.33 to 0.72. The adoption of our tool has the potential to improve the usability of medical emergency guidelines.

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Section: Cognitive Aid Descriptionmentioning

confidence: 99%

Cognitive Aids in Medicine Assessment Tool (CMAT): preliminary validation of a novel tool for the assessment of emergency cognitive aids

et al. 2015

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“…inability to notice large-format ACLS cognitive aids partially blocking the defibrillator screen [13]). Therefore, repetitive training may improve the familiarity with a CA and enhance the chance of it being used effectively during actual emergencies [10, 11, 13]. …”

Section: Discussionmentioning

confidence: 99%

Does an electronic cognitive aid have an effect on the management of severe gynaecological TURP syndrome? A prospective, randomised simulation study

et al. 2017

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BackgroundLack of familiarity with the content of current guidelines is a major factor associated with non-compliance by clinicians. It is conceivable that cognitive aids with regularly updated medical content can guide clinicians’ task performance by evidence-based practices, even if they are unfamiliar with the actual guideline. Acute hyponatraemia as a consequence of TURP syndrome is a rare intraoperative event, and current practice guidelines have changed from slow correction to rapid correction of serum sodium levels. The primary objective of this study was to compare the management of a simulated severe gynaecological transurethral resection of the prostate (TURP) syndrome under spinal anaesthesia with either: an electronic cognitive aid, or with management from memory alone. The secondary objective was to assess the clinical relevance and participant perception of the usefulness of the cognitive aid.MethodsAnaesthetic teams were allocated to control (no cognitive aid; n = 10) or intervention (cognitive aid provided; n = 10) groups. We identified eight evidence-based management tasks for severe TURP syndrome from current guidelines and subdivided them into acute heart failure (AHF)/pulmonary oedema tasks (5) and acute hyponatraemia tasks (3). Implementation of the treatment steps was measured by scoring task items in a binary fashion (yes/no). To assess whether or not the cognitive aid had prompted a treatment step, participants from the cognitive aid group were questioned during debriefing on every single treatment step. At the end of the simulation, session participants were asked to complete a survey.ResultsTeams in the cognitive aid group considered evidence-based treatment steps significantly more often than teams of the control group (96% vs. 50% for ‘AHF/pulmonary oedema’ p < 0.001; 79% vs. 12% for ‘acute hyponatraemia’ p < 0.001). Without the cognitive aid, performance would have been comparable across both groups. Nurses, trainees, and consultants derived equal benefit from the cognitive aid.ConclusionsThe cognitive aid improved the implementation of evidence-based practices in a simulated intraoperative scenario. Cognitive aids with current medical content could help to close the translational gap between guideline publication and implementation in acute patient care. It is important that the cognitive aid should be familiar, in a format that has been used in practice and training.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-017-0365-8) contains supplementary material, which is available to authorized users.

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“…The use of checklists and cognitive aids can improve standardisation, teamwork and overall performance in operating theatres and during crisis situations [43,[176][177][178][179][180][181], and several have been described for use in general [45,182] and obstetric anaesthesia [44,183,184].…”

Section: Teachingmentioning

confidence: 99%

Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

Mushambi¹,

Kinsella²,

Popat³

et al. 2016

Obstetric Anesthesia Digest

114

221

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SummaryThe Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably secondgeneration) supraglottic airway device if appropriate. Algorithm 3 covers the management of the 'can't intubate, can't oxygenate' situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to awaken or proceed with surgery. The background paper covers recommendations on drugs, new equipment, teaching and training.

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Cognitive aids: time for a change?

Cited by 21 publications

References 33 publications

Cognitive Aids in Medicine Assessment Tool (CMAT): preliminary validation of a novel tool for the assessment of emergency cognitive aids

Cognitive Aids in Medicine Assessment Tool (CMAT): preliminary validation of a novel tool for the assessment of emergency cognitive aids

Does an electronic cognitive aid have an effect on the management of severe gynaecological TURP syndrome? A prospective, randomised simulation study

Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

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